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Suicide prevention in low- and middle-income countries: part perceptions, partial solutions

  • K. S. Jacob (a1)

Suicide, a common cause of death in many low- and middle-income countries, has often been viewed through a medical/psychiatric lens. Such perspectives medicalise social and personal distress and suggest individual and medication-based treatments. This editorial argues for the need to examine suicide from a public health perspective and suggests the need for population-based social and economic interventions.

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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Suicide prevention in low- and middle-income countries: part perceptions, partial solutions

  • K. S. Jacob (a1)
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Small wins: A demonstrable pathway to population-based suicide prevention. The example from Ghana.

Emmanuel Nii-Boye Quarshie, PhD Candidate, University of Leeds
Johnny Andoh-Arthur, PhD Candidate, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
16 February 2018

We read with keen interest K. S. Jacob’s editorial argument (1) for the importance of examining suicide from a public health perspective and the need for population-based social and economic interventions towards suicide prevention in low- and middle-income countries (LMICs). We agree with the author and wish to point that scaling up suicide research and interventions to population levels, will remain but a long haul across LMICs. In a similar editorial some 17 years ago, De Leo (2) emphasised the need for multidisciplinary, multilevel, holistic approaches to suicide prevention. However, to date, there has not been any concrete shift in response to this call, particularly within LMICs. Harsh public attitudes towards suicide and lack of funding for research within LMICs are particularly of note, in this regard.

We argue, drawing on our experience (with a small team of suicide researchers in Ghana; a sub-Saharan African country with about 28 million people), that perhaps a potentially demonstrable pathway to population-based suicide prevention in LMICs is to coordinate the various concrete “small wins” (3) of local community-level suicide prevention efforts to push for much more broader population-based prevention programmes. In Ghana, as persisting in virtually all LMICs, suicide prevention has not received the needed priority and policies, and allocation of resources for addressing the challenge is non-existent. Paradoxically, suicide remains an almost-everyday-reality in the country (4), and few professionals are available to help deal with the challenge . The small team of local suicidologists in the country (at the Centre for Suicide and Violence Research in the University of Ghana) have for the past years, self-funded their research and implementation programmes at various local community levels. Adopting the “small wins” principle, (3), the team has gradually but incrementally made its impact more visible over the past eight years. For instance, recently, the Judicial Service of Ghana in collaboration with the Ghana Mental Health Authority arranged for the team to train judges and magistrates across the country on the importance of decriminalising attempted suicide in the country and the need for the diversion of offenders of the antisuicide law from the criminal justice system into the mental healthcare system. Presently, the team is beginning to attract small-to-moderate funding from University-based research funders to scale up suicide research and prevention efforts to the national level.

Small wins achieved at the local community levels in suicide research and prevention have the potential to attract resources (funding) and favourable alliances. This will help set in motion larger wins at the broader population level.

1. Jacob KS. Suicide prevention in low-and middle-income countries: part perceptions, partial solutions (Editorial). BJPsych. 2017;211:264-5.

2. De Leo D. Why are we not getting any closer to preventing suicide? (Editorial). Br J Psychiatry. 2002;181(372e4).

3. Weick KE. Small wins: Redefining the scale of social problems. American Psychologist. 1984;39(1):40-9.

4. Knizek BL, Akotia CS, Hjelmeland H. A qualitative study of attitudes toward suicide and suicide prevention among psychology students in Ghana. OMEGA-Journal of Death and Dying. 2011;62(2):169-86.
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Conflict of interest: None declared

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